Traumatology and orthopedics. Treatment methods in traumatology and orthopedics Surgical treatment methods in traumatology

Methods of treatment in traumatology and orthopedics When providing medical care and treating victims, it is necessary to perform the following tasks: preserve the life of the patient, restore the integrity of the damaged bone, the function of the damaged limb and the patient’s previous performance. In this case, the following principles of treating patients must be observed: 1. Providing emergency assistance. 2. Reposition of fragments should be carried out with adequate pain relief. 3. In case of fractures with displaced fragments, reposition should be carried out using conservative or surgical methods (as indicated). 4. Before consolidation occurs, the fragments must be stationary. 5. Restorative treatment should begin as early as possible and contribute to the rapid restoration of the function of the damaged organ and the performance of the victim.

To accomplish these tasks and implement the principles of treatment, all known and available treatment methods must be applied.

In orthopedic and traumatological practice, both conservative and surgical methods are used. Each of the methods listed below is used in all clinics according to indications. At the same time, preference is given to those methods that are most rational in a given situation. The choice of treatment method depends, first of all, on the scientific direction of the school of a given medical institution. A conservative method of treatment in modern traumatology and orthopedics is represented by the fixation and extension method.

The fixation method of treatment involves the use of plaster and other materials to create rest for the damaged (sick) limb segment. In this case, the bandage does not have any effect on bone fragments, but only fixes the damaged segment or part of the limb. Therefore, after reducing the swelling of the segment enclosed in a plaster cast, secondary displacement of fragments may occur. This method is used for fractures without displacement of fragments, after simultaneous manual reposition of fragments, with extensive damage to soft tissues, and sometimes after operations on segments of the musculoskeletal system.

Plaster casts can be either in the form of splints (Fig. 1.) or in the form of circular bandages (Fig. 2). If a circular plaster cast is used in the early post-traumatic period, the patient should be left for further treatment and observation in a specialized medical department until the swelling of the injured limb segment decreases or completely disappears. If a plaster splint is used for treatment, the patient can carry out further treatment on an outpatient basis.

Circular plaster casts are contraindicated in the following cases: with significant swelling of the damaged segment, its doubtful viability, caused by damage to the great vessels, with extensive damage to soft tissues. If, in case of periarticular or intra-articular injuries, a circular plaster cast is absolutely necessary, then in these cases the bandage is cut above the joint or a “track” is cut out to reduce compression of damaged tissues by swelling.

When fixing a damaged segment with a plaster cast, the following rules must be observed: fix the damaged segment together with adjacent joints. The plaster cast should securely fix the damaged segment and not lead to additional trauma to the soft tissues. To do this, before applying the plaster cast, the bony protrusions are covered with a layer of cotton wool. The plaster cast must completely follow the contours of the segment being fixed. To observe a limb in a plaster cast, it is necessary to make the toes or hands accessible for inspection.

In cases where signs of circulatory or sensitivity problems appear, the circular bandage must be cut or removed, replacing it with a splint. To reduce swelling of the injured limb, it is necessary to create an elevated position. After the swelling has subsided (days 5–7 of the post-traumatic period), the patient must undergo an X-ray examination of the fracture through a plaster cast in order to timely identify possible secondary displacement of the fragments.

If, after the swelling subsides, the plaster cast becomes loose and does not securely fix the damaged segment, then such a bandage should be cut, compressed and further strengthened with plaster bandages. The fixation method of treatment is relatively simple and allows you to quickly restore the victim’s motor activity. However, long-term fixation of the limb with a bandage and associated physical inactivity lead to muscle wasting and the development of contractures of the joints of the damaged segment of the limb.

This requires lengthening the period of rehabilitation treatment. In addition, if a circular plaster cast is applied incorrectly, compression of the soft tissues is possible, which can lead to pressure sores or severe ischemia of the damaged limb segment with the possible development of gangrene. Extension method of treatment. For traumatic injuries of the extremities, the method of constant skeletal traction is widely used in our country.

Cuff, glue and other methods of traction are used as auxiliary. The purpose of the method is to gradually reduce the fragments using weights and hold them in the correct position until the formation of a primary callus (4 - 6 weeks). The method is used in cases where one-step manual reduction cannot be performed. For some types and locations of fractures, it is the main one (fractures of the diaphysis of the shoulder, femur, tibia). Prolonged bed rest.

As an integral part of this method of treating fractures, it does not allow it to be widely used in elderly and senile people. In children, due to the existing zones of epiphyseal growth in the tubular bones, the use of skeletal traction with large loads is very limited. Some pediatric traumatologists recommend using this method only from adolescence. For treatment using the method of constant skeletal traction, it is necessary to pass a Kirschner wire through a certain point, depending on the location of the fracture.

The pin is carried out under local anesthesia. The main points for the pins are for the upper limb, for fractures of the scapula and shoulder - the olecranon, for the lower limb, for fractures of the pelvis and femur - its supracondylar region or the tibial tuberosity. For fractures of the tibia, the pin is passed through the supramalleolar region, and for injuries to the ankle joint and lower leg in the lower third of the diaphysis, through the heel bone.

After passing the needle through the bone, it is secured in a bracket of a special design, and then the initial reduction load is installed through a system of blocks: for shoulder fractures - 2-4 kg, hip - 15% of the victim’s weight, for tibia fractures - 10%, and for fractures pelvis - by 2-3 kg. more than for hip fractures. An individual reduction weight is selected based on a control radiograph 24-48 hours after the start of treatment. After changing the load along the axis of the damaged segment or shifting the direction of the lateral reduction loops, X-ray control of the fracture site is required after 1-2 days.

When treated using the method of constant skeletal traction, the injured limb must occupy a certain forced position. Thus, in case of fractures of the scapula, the arm should occupy the following position: in the shoulder joint - abduction to an angle of 90, in the elbow - flexion of 90 (Fig. 3). The forearm should be in the middle position between pronation and supination and fixed with adhesive traction with a load along the axis of the forearm up to 1 kg. For shoulder fractures, the position of the hand is almost the same, only in the shoulder joint the hand is in a position of flexion to an angle of 90°. For fractures of the lower limb, the leg is placed on a Beler splint, the design of which allows for uniform relaxation of antagonist muscles.

A reliable clinical criterion for the sufficiency of treatment using the method of constant skeletal traction is the disappearance of pathological mobility at the fracture site, which must be confirmed x-ray. After this, they switch to the fixation method of treatment. The method of constant skeletal traction allows you to avoid muscle wasting of the damaged limb, quickly begin restorative treatment, traction allows you to ensure the immobility of bone fragments while maintaining joint mobility and muscle function. The limb is not compressed by the bandage, blood circulation is not impaired, which accelerates the formation of callus, prevents atrophy, the formation of bedsores and other complications.

The diseased limb is accessible for examination, and movements begin from the first days of treatment. The inconvenience of the method is that the patient is forced to be “bedridden”; the method requires long-term bed rest and special care for the patient, increasing the length of hospital stay.

Possible complications of the method include inflammatory processes of varying depth at the site of the traction wires. Extrafocal compression-distraction method of treatment. This is what its founder, Professor G. A. Ilizarov called it. He also proposed an apparatus of his own design, which consists of metal rings of various diameters and telescopic rods for connecting these rings.

The essence of this semi-operative – semi-conservative method of treatment is that the bones in the damaged area are not interfered with. Sometimes the fracture site is not even exposed. Above and below the fracture, two pairs of wires are placed (the same as for skeletal traction, only of a larger diameter) in mutually perpendicular planes. Then, in pairs, these knitting needles are secured in rings, which are connected to each other by rods, most often in series. The device, consisting of 4 rings (two each on the central and peripheral fragments), allows you to reduce fragments and create sufficient compression in the fracture zone for reliable healing of the existing damage .

With false joints, they first create sufficient compression to allow the destruction of soft tissue in the area of the pathological process, and then begin to gradually remove the rings of the apparatus from each other - distraction, achieving “revival” of reparative osteogenesis at the site of the false joint, achieving complete consolidation and restoration of bone continuity.

Using an apparatus of his own design, Ilizarov proposed to lengthen the limbs (Fig. 4). The advantages of this treatment method are obvious: achieving reposition using a closed method, the ability to “manage” fragments, creating dosed immobility in the area where bone integrity is damaged, a short stay for the patient in the hospital, no need for long-term bed rest, etc. This method is indispensable for open fractures, for fractures with large defects of the integumentary tissue, for comminuted, complicated fractures.

The absence of fixation of the joints adjacent to the fracture makes it possible to prescribe therapeutic exercises early, resulting in a significantly shorter rehabilitation period. Of course, the presence of damage to the integrity of the integumentary tissues in the places where the wires are inserted can contribute to the occurrence of purulent-inflammatory complications. However, with proper care of the skin near the wires of the device, the frequency of such complications is negligible. Surgical method of treatment. The essence of the method is that ideal reposition of fragments is achieved in an open way, and their reliable fixation is carried out with metal structures of various types. It is a mistake to think that bone tissue regeneration improves after metal osteosynthesis. “The rate of osteogenesis” is a constant value, and the presence of a foreign body, which is a metal fixator, in the fracture zone cannot contribute to the fastest healing of the fracture. However, the advantages of the method include its reliability, although opening the site of bone damage can lead to quite severe local complications.

Indications for surgical treatment include open fractures, fractures complicated by damage to the great vessels and nerves, avulsion fractures with the formation of significant diastasis between the fragments.

The operation is indicated for the interposition of soft tissues and fragments in the fracture zone, the penetration of muscles and fascia between the fragments, which interfere with the formation of callus, for irreducible (for example, an isolated fracture of the tibia) and unrestrained fractures (for an oblique fracture plane, helical fractures), and for unsuccessful closed manual reduction of fragments.

In other words, if there is no effect from the use of conservative treatment methods. In recent years, the indications for surgical treatment of fractures have been somewhat expanded. Thus, a relative indication for surgery is the presence of transverse diaphyseal fractures, insufficiently accurate reduction when treated with skeletal traction, etc. For some fracture locations, the surgical method is the main one, as, for example, for femoral neck fractures.

In some countries, the indication for surgery is the presence of a fracture with displacement of fragments. Various metal structures are used for osteosynthesis. In recent years, external osteosynthesis using compression plates with screws has become widespread (Fig. 5). The method makes it possible to reliably fix fragments for the entire period of consolidation and completely abandon external fixation of the injured limb in the postoperative period.

This significantly reduces the recovery time for victims. It should be noted that the number of complications is significantly higher in operated patients than in those who received conservative treatment methods. Therefore, in the preoperative period, the victim should be carefully examined to identify contraindications to surgical intervention. These include the general serious condition of the patient due to concomitant trauma.

In these cases, preliminary treatment of fractures is carried out against the background of adequate treatment of the dominant injury. The same is done with patients whose early post-traumatic period was complicated by shock. At the same time, the patient is brought out of shock and only after this is it possible to carry out open reposition of the fracture and metal osteosynthesis. If the serious condition of the victim is due to ongoing arterial bleeding, then in these cases it is necessary to reliably stop the bleeding in the wound, achieve stable stabilization of blood pressure, and only in this case continue surgery.

They do not operate on patients with severe forms of decompensation of chronic concomitant pathology, if there are signs of inflammation at the site of the intended incision. The operation is not indicated for patients with fractures of the lower extremities if they were not walking before the injury. However, it should be noted that the achievements of modern anesthesiology make it possible to operate on patients who at first glance seemed inoperable due to concomitant pathology.

Therefore, contraindications to surgical treatment of fractures are decreasing every year. Thus, various treatment methods have the right to exist and be used. The main thing is to choose the optimal treatment method with minimal risk to the patient’s health. List of references 1. Lebedev V.V. Okhotsky V.P. Kanshin N.N. Emergency care for combined traumatic injuries.

M Medicine, 1980 2. Lisitsyn K.M. Military field surgery. M 1982 3. Operative orthopedics. M 1983 4. Nikitin G.D. Multiple fractures and associated injuries. L Medicine, 1983 5. Epifanov V.A. Operative traumatology and rehabilitation of patients. M 1983 6. Kaplan A.V. Makhson N.E. and others. Purulent traumatology of bones and joints. M 1985 7. Kolontai Yu.Yu Panchenko M.K Andruson M.V Vasiliev S.F. Open hand injuries. Kyiv, Health, 1993

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Traumatology and orthopedics– two closely related areas of medicine that study, treat and prevent pathologies of the musculoskeletal system. These areas are based, on the one hand, on a deep comprehensive understanding of the structure and function of the musculoskeletal system, on the other hand, on the latest advances in technological process, which have made possible previously unattainable results in the treatment of injury, its consequences and non-traumatic injuries of the musculoskeletal system. Orthopedics and traumatology are associated with thoracic surgery, rheumatology, neurology, podology, and disaster medicine.

The medical importance of these disciplines has increased in recent years due to the prevalence of musculoskeletal diseases. The incidence of lesions of the musculoskeletal system in Russia over the past 5 years has increased by 21%, including among children and adolescents - by 22% and 47%, respectively. Diseases treated by traumatologists and orthopedists sharply reduce the quality of life: they impair movement, impair the ability to work and self-care, and debilitate patients with chronic pain. Traumatology refers to emergency types of medical care; its importance can hardly be overestimated in the event of various emergencies, man-made disasters, accidents, explosions, etc.

Specialists in the field of traumatology and orthopedics in Moscow treat bone fractures, traumatic dislocations, joint diseases and injuries, injuries to muscles and tendons of the extremities, multiple combined injuries, sports injuries and their consequences, joint replacement, treatment of foot deformities, spine surgery and much more. etc. Doctors also treat burn injuries and frostbite, soft tissue wounds, and scars. If the patient cannot go to the clinic in person, orthopedists and traumatologists provide consultations to patients at home.

Assistance in the field of orthopedics and traumatology in Moscow is provided by specialized departments of large clinics, specialized medical centers, emergency rooms of public and private medical institutions. The scope of diagnostic and therapeutic measures is determined by the type and level of a specific unit. The mandatory minimum of outpatient care includes radiography, application of plaster and plastic bandages, reposition of small bone fractures, reduction of dislocations and postoperative surgical treatment of superficial wounds. Trauma departments in Moscow carry out classical operations, perform high-tech surgical interventions using minimally invasive and endoscopic technologies, and also carry out effective rehabilitation in the postoperative period.

Specialists make a diagnosis, choose treatment tactics and carry out therapeutic measures based on anamnestic data (medical history, circumstances of injury), the results of an external examination, instrumental data (radiography, CT, MRI, arthroscopy) and laboratory (clinical tests) research methods, the conclusions of others specialists. Both conservative and surgical treatment methods are widely used in this area.

In recent decades, there has been a tendency to expand the indications for surgical interventions in the treatment of traumatic injuries. Conservative therapy in traumatology is combined with open manipulations, such as local anesthesia, joint puncture, insertion of needles, etc. Local treatment in traumatology is complemented by general therapy. In Moscow traumatology departments, patients are prescribed analgesics, for open injuries - courses of antibiotics, and for severe pathology, blood transfusions and infusion therapy are given.

The widespread use of surgical techniques makes it possible to reduce treatment time, achieve early activation of patients, improve long-term treatment results and reduce patient discomfort. A striking example is the replacement of skeletal traction, in which the patient was forced to remain in the hospital in a supine position for four or more weeks, with intraosseous, extraosseous or transosseous osteosynthesis. A few days after the operation, the patient can get up, begins to move actively, and after the sutures are removed, as a rule, he is discharged for outpatient treatment.

The active use of surgical methods has become possible thanks to modern materials and new hardware techniques. Pins, plates and nails for extraosseous and intraosseous osteosynthesis are intact in relation to the surrounding tissues, which reduces the incidence of complications after operations. The use of modern gentle surgical techniques (arthroscopy, etc.) makes it possible to minimize tissue damage during surgery, which also reduces the number of complications and significantly shortens the rehabilitation period after surgical interventions.

In orthopedics and traumatology, it is difficult to overestimate the importance of an integrated approach to patient treatment. Physiotherapy, physical therapy, manual therapy and massage are used for the treatment and rehabilitation of patients. These techniques are of particular importance and are included in the mandatory rehabilitation program for patients with injuries of bones and joints. In adult and pediatric orthopedics, various orthopedic devices are actively used (corsets, bandages, insoles, orthoses, orthopedic shoes, etc.). Long-term wearing of devices can improve the patient's condition, reduce pain, stop the progression of the disease or achieve significant improvement.

It is worth noting the role of pediatric orthopedics in the correction of congenital and acquired pathological changes in the musculoskeletal system in children. The child’s body has enormous compensatory capabilities; it grows and develops, so in childhood, with a properly selected treatment regimen, it often becomes possible to eliminate or significantly reduce pathological changes in the musculoskeletal system. In pediatric and adult orthopedics, long-term treatment techniques are often used, lasting months and even years. The success of therapy in such cases depends to a large extent on the patient, his mood and willingness to follow all the doctor’s instructions.

The choice of treatment methods in Moscow traumatology and orthopedics clinics is determined by the type of pathology, medical history, patient’s age, the presence of concomitant diseases and other circumstances. The doctor draws up a treatment plan taking into account all factors. During treatment, the specialist can adjust and supplement the therapy regimen to achieve the best result.

The “Traumatology and Orthopedics” section on the pages of the “Beauty and Medicine” website contains information about Moscow clinics providing specialized services. Modern advances in these areas of practical medicine make it possible to activate the patient and return him to everyday and work activities in the shortest possible time.

When providing medical care and treating victims, the following must be done: tasks: to save the patient’s life, restore the integrity of the damaged bone, the function of the damaged limb and the patient’s previous performance. In this case, the following principles of patient treatment must be observed:

1. Providing emergency assistance.

2. Reposition of fragments should be carried out with adequate pain relief.

3. In case of fractures with displaced fragments, reposition should be carried out using conservative or surgical methods (as indicated).

4. Before consolidation occurs, the fragments must be stationary.

5. Restorative treatment should begin as early as possible and contribute to the rapid restoration of the function of the damaged organ and the performance of the victim.

To accomplish these tasks and implement the principles of treatment, all known and available must be applied treatment methods.

A conservative method of treatment in modern traumatology and orthopedics is represented by the fixation and extension method.

Fixation The treatment method involves the use of plaster and other materials to create rest for the damaged (sick) limb segment. In this case, the bandage does not have any effect on bone fragments, but only fixes the damaged segment or part of the limb. Therefore, after reducing the swelling of the segment enclosed in a plaster cast, secondary displacement of the fragments may occur.

This method is used for fractures without displacement of fragments, after simultaneous manual reposition of fragments, with extensive injuries to soft tissues, and sometimes after operations on segments of the musculoskeletal system.

Circular plaster casts contraindicated in the following cases: with significant swelling of the damaged segment, its doubtful viability, caused by damage to the main

vessels, with extensive damage to soft tissues. If, in case of peri-articular or intra-articular injuries, a circular plaster cast is absolutely necessary, then in these cases the bandage is cut over the joint or a “track” is cut out to reduce compression of the damaged tissues by swelling.

When fixing the damaged segment with a plaster cast, the following must be observed: rules: fix the damaged segment together with adjacent joints. The plaster cast should securely fix the damaged segment and not lead to additional soft tissue injury. To do this, before applying a plaster cast, the bone protrusions are covered with a layer of cotton wool. The plaster cast must completely follow the contours of the segment being fixed. To observe a limb in a plaster cast, it is necessary to make the toes or hands accessible for inspection. In cases where signs of circulatory or sensitivity problems appear, the circular bandage must be cut or removed, replacing it with a splint. To reduce swelling of the injured limb, it is necessary to create an elevated position. After the edema subsides (days 5–7 of the post-traumatic period), the patient must undergo an X-ray examination of the fracture through a plaster cast in order to timely identify possible secondary displacement of the fragments. If, after the swelling subsides, the plaster cast becomes loose and does not securely fix the damaged segment, then such a bandage should be cut, compressed and further strengthened with plaster bandages.

The fixation method of treatment is relatively simple and allows you to quickly restore the victim’s motor activity. However, long-term fixation of the limb with a bandage and associated physical inactivity lead to muscle wasting and the development of joint contractures in the damaged segment of the limb. This requires lengthening the period of rehabilitation treatment. In addition, if a circular plaster cast is applied incorrectly, compression of the soft tissues is possible, which can lead to pressure sores or severe ischemia of the damaged limb segment with the possible development of gangrene.

Extensional treatment method . For traumatic injuries of the extremities, the method of constant skeletal traction is widely used in our country. Cuff, glue and other methods of traction are used as auxiliary.

Purpose of the method– gradual reduction of fragments with the help of weights and holding them in the correct position until the formation of primary callus (4 – 6 weeks).

The method is used in cases where one-step manual reduction cannot be performed. For some types and locations of fractures, it is the main one (fractures of the diaphysis of the shoulder, femur, tibia). Prolonged bed rest. As an integral part of this method of treating fractures, it does not allow it to be widely used in elderly and senile people. In children, due to the existing zones of epiphyseal growth in the tubular bones, the use of skeletal traction with large loads is very limited. Some pediatric traumatologists recommend using this method only from adolescence.

For treatment using the permanent skeletal traction method, it is necessary to pass a Kirschner wire through a certain point depending on the location of the fracture. The needle is performed under local anesthesia. The main points for conducting the pins are for the upper limb; for fractures of the scapula and shoulder - the olecranon; for the lower limb, for fractures of the pelvis and femur - its supracondylar region or the tibial tuberosity. For fractures of the tibia, the pin is passed through the supramalleolar region, and for injuries to the ankle joint and lower leg in the lower third of the diaphysis, through the heel bone.

After passing the needle through the bone, it is secured in a bracket of a special design, and then the initial reduction load is installed through a system of blocks: for shoulder fractures - 2-4 kg, hip - 15% of the victim’s weight, for tibia fractures - 10%, and for fractures pelvis - by 2-3 kg. more than for hip fractures. An individual reduction weight is selected based on a control radiograph 24-48 hours after the start of treatment. After changing the load along the axis of the damaged segment or shifting the direction of the lateral reduction loops, X-ray monitoring of the fracture site is required after 1-2 days.

When treated with constant skeletal traction, the injured limb must occupy a certain forced position. So, in case of fractures of the scapula, the hand should take the following position: in the shoulder joint - abduction to an angle of 90°, in the elbow joint - flexion of 90° (Fig. 3). The forearm should be in the middle position between pronation and supination and fixed with adhesive traction with a load along the axis of the forearm up to 1 kg. For shoulder fractures, the position of the hand is almost the same, only in the shoulder joint the hand is in a position of flexion to an angle of 90°. For fractures of the lower limb, the leg is placed on a Beler splint, the design of which allows for uniform relaxation of antagonist muscles.

The duration of bed rest depends on the location of the fracture. Thus, for fractures of the scapula, shoulder, and tibia, treatment continues for 4 weeks, and for fractures of the pelvis and hip - 6 weeks. A reliable clinical criterion for the sufficiency of treatment using the method of constant skeletal traction is the disappearance of pathological mobility at the fracture site, which must be confirmed x-ray. After this, they switch to the fixation method of treatment.

The method of constant skeletal traction allows you to avoid muscle wasting of the injured limb, quickly begin restorative treatment, traction allows you to ensure the immobility of bone fragments while maintaining joint mobility and muscle function. The limb is not compressed by the bandage, blood circulation is not impaired, which accelerates the formation of callus,
prevents atrophy, formation of bedsores and other complications. The affected limb is accessible for inspection, and movements begin from the first days of treatment.
The inconvenience of the method is that the patient is forced to be bedridden; the method requires long-term bed rest and special care for the patient, increasing the length of hospital stay.

Possible complications of the method include inflammatory processes of varying depth at the site of the traction wires.

Extrafocal compression-distraction treatment method. This is what its founder, Professor G. A. Ilizarov, called it. He also proposed an apparatus of his own design, which consists of metal rings of various diameters and telescopic rods for connecting these rings. The essence of this semi-operative – semi-conservative method of treatment is that the bones in the damaged area are not interfered with. Sometimes the fracture site is not even exposed. Above and below the fracture, two pairs of wires are placed (the same as for skeletal traction, only of a larger diameter) in mutually perpendicular planes. Then, in pairs, these knitting needles are secured in rings, which are connected to each other by rods, most often in series. The device, consisting of 4 rings (two each on the central and peripheral fragments), allows you to reduce fragments and create sufficient compression in the fracture zone for reliable healing of the existing damage. With false joints, they first create sufficient compression to allow the destruction of soft tissue in the area of the pathological process, and then begin to gradually remove the rings of the apparatus from each other - distraction, achieving “revival” of reparative osteogenesis at the site of the false joint, achieving complete consolidation and restoration of bone continuity. Using an apparatus of his own design, Ilizarov proposed to lengthen the limbs (Fig. 4).

The main principles of treatment are:

1) preserving the life of the victim;

2) elimination of anatomical disorders of the skeleton that interfere with the normal functioning of organs (skull, chest, pelvis, spine);

3) restoration of function of the damaged body segment.

To treat diseases and injuries of the musculoskeletal system (MSA), conservative, surgical and combined methods are used.

Conservative methods. TO conservative methods include the application of plaster casts, traction and redressing.

Plaster casts. Among the hardening dressings, the most widespread is plaster, which is evenly and tightly

adheres to the body, hardens quickly, and is easily removed. A correctly applied plaster cast holds the associated fragments well and provides immobilization (immobility) of the injured limb.

Plaster casts are divided into longitudinal, circular - blind and dissected (Fig. 2), as well as bridge-like, figured, windowed.

When applying a plaster cast, the following rules must be observed:

1) to ensure immobility and rest of the injured limb, it is necessary to fix it using two or three joints;

2) give the limb a functionally advantageous position (for the upper limb - shoulder abduction up to 60°, flexion in the shoulder joint up to 30°, flexion in the elbow joint up to 90°, extension in the wrist joint up to 150°, flexion of the fingers in the position of holding a tea glass; for the lower limb - hip abduction up to 160°, hip flexion up to 170°, knee flexion up to 175°, neutral foot position (90°);

Rice. 2. Typical circular and splint dressings:

A- large (“boot”) and small (“boot”) bandages for the lower limb; b-

hip; V - thoracobrachial; G - corset; d - corset with head holder

tele; e-z- splint dressings according to Turner, Volkovich, Weinstein

3) when casting, keep the limb motionless;

4) to monitor the condition of the injured limb, leave the terminal phalanges open;

5) until the plaster cast is completely dry, handle it carefully, as it may break.

A circular plaster cast requires careful observation in the first 24-48 hours after application, as edema may develop, causing compression of the limb, which can lead to complications, including ischemic contracture, paralysis and gangrene of the limb.

Traction. With the help of constant traction, acting in doses and gradually, muscle retraction is overcome, which makes it possible to eliminate the displacement of bone fragments, dislocations, contractures, deformations, and also makes it possible to keep the fragments in the required position.

Currently, the most common types of traction are adhesive and skeletal.

Adhesive traction is used for certain indications; it is less widespread than the skeletal one. During this traction, the weight of the load (even on the hip) should not exceed 2 - 5 kg.

For bandages, strips of adhesive plaster, glue of various compositions (cleol and zinc-gelatin paste), and cloth bandages of various widths are used. Skin irritation is possible. Adhesive traction is used in the treatment of hip fractures in children under 3 years of age.

Skeletal traction is more often used in the treatment of oblique, helical and comminuted fractures of the long tubular bones of the pelvis, upper cervical vertebrae, bones in the ankle joint, and heel bone. Skeletal traction can be performed at almost any age (in children after 5 years); it has few contraindications.

In our daily lives, various injuries often occur: from ordinary dislocations to complex fractures. Their treatment, as well as subsequent recovery, requires a long time, and sometimes the skill of the doctors directly determines whether the patient can maintain quality of life and return to active work. "

Our Orthopedics and Traumatology Clinic provides expert diagnosis and treatment of injuries and orthopedic pathologies of any degree of complexity, including modern minimally invasive surgical methods, using the latest materials and technologies. This ensures a speedy recovery and restoration of motor functions impaired by injury or illness. Our orthopedists and traumatologists have all the capabilities of the Clinical Hospital on Yauza - an advanced diagnostic complex equipped with the latest technology, a hospital with a high-tech operating unit, an outpatient department with all specialized specialists, which allows us to provide a quick, accurate diagnosis, an individual approach and comprehensive effective treatment.

We cooperate with leading specialists, including from university clinics. Based on our extensive practical experience and knowledge, we successfully work with patients of all ages, using a variety of treatment methods that have proven themselves in the best clinics in Europe, the USA and Israel.

Areas of work

General traumatology- diagnosis, conservative and surgical treatment of any injuries and damage to the musculoskeletal system (bruises, wounds, bone fractures, sprains, dislocations, other joint injuries, etc.) for maximum recovery - anatomical and functional injured tissues, bones and joints.
Vertebrology, operative and conservative- highly effective treatment of various diseases and injuries of the spine, including severe high-energy injuries, radicular syndromes, stenosis, scoliosis and others.
Treatment of consequences of injuries, complications after orthopedic operations- treatment of improperly healed fractures, false joints, bone deformations, postoperative osteomyelitis, etc.
Microsurgery- surgical treatment of congenital and acquired deformities of the hand, foot, and consequences of injuries.
Pediatric orthopedics and traumatology- early detection of various pediatric orthopedic pathologies, its timely correction with the possibility of complete anatomical and functional restoration.
Treatment of consequences of injuries, complications after orthopedic operations - treatment of improperly healed fractures, false joints, bone deformations, postoperative osteomyelitis, etc.
Treatment of tunnel syndromes, other diseases of the hand and forearm.
Correction of curvature of the limbs, post-traumatic deformities, lengthening and shortening, alignment of the limbs - a complex set of therapeutic measures that we use for unequal limb lengths, deformities, aesthetic disorders, including after injuries. The capabilities of radiation diagnostics allow you to accurately diagnose pathology and monitor the treatment process over time.

To work in each area, the Clinic of Traumatology and Orthopedics of the Yauza Clinical Hospital has attracted the best specialists in their field, who have unique techniques and provide conservative and surgical treatment at the highest level.

Best practices and innovation

Arthroscopy of large joints- endoscopic operations on joints, without opening the joint cavity. They shorten the recovery period, the duration of hospitalization, and improve the outcome of treatment. Arthroscopic surgeries are performed by leading specialists on the shoulder, knee, elbow, wrist, and ankle joints.
Endoprosthetics joints, including subtotal and total - complete or partial replacement of a destroyed joint with an artificial one, which allows patients to remain active and lead a normal lifestyle (the nature of the chosen operation depends on the degree of damage to the joint).
Osteosynthesis- surgical treatment of fractures, an operation to connect bone fragments and fix them for reliable fusion in order to best restore the anatomy and function of damaged bones and joints. The doctor chooses the optimal method of osteosynthesis for each specific case and patient.
Reconstructive surgeries- restoration of bones deformed for various reasons and returning them to the ability to function normally. Including the removal of cones on the legs (halius valgus), straightening the limbs, eliminating their deformities, etc.
Neurosurgical operations on the spine, including:
- Endoscopic removal of spinal disc herniations
- Prosthetics of discs, prosthetics of vertebral bodies using sliding cages, vertebroplasty - strengthening of vertebral bodies through the introduction of special bone cement. Can be used for compression fractures, osteoporosis, spinal tumors, and other pathologies.
- Treatment of spinal stenosis - spinal cord decompression with vertebral stabilization
- Surgical treatment of spinal deformities in adults (including ankylosing spondylitis) and children - straightening the deformed spinal column and restoring the patient’s posture
- Treatment of consequences of spinal injuries of all categories of complexity
- Revision surgeries for unsuccessfully operated spine
PRP therapy- a high-tech method of treating injuries, orthopedic diseases (degenerative-dystrophic, chronic, bursitis, epicondylitis, arthrosis, etc.) with injections of one’s own platelet-rich blood plasma, stimulating tissue regeneration (damaged ligaments, cartilage, joint capsule, etc.). We carry it out by double centrifugation of blood components, which increases the concentration of platelets by 3.5-5.8 times (up to that required for PRP therapy) compared to a single centrifugation (with plasma lifting).

Complex treatment

Hospital with operating unit

A hospital with three operating rooms equipped with high-tech equipment and comfortable rooms with functional beds that allow you to give the body a comfortable position. Patients are provided with 24-hour medical supervision. Individual TV. Delicious dietary food.

Rehabilitation

During the recovery period, patients are under outpatient supervision of an orthopedic traumatologist. For a speedy recovery, PRP therapy, manual techniques, massage, etc. can be used.